Denis Paul Juge's previous Expert Commentary on "Status of PPO Litigation in Louisiana: What’s the Problem?" gave a general overview of the litigation in Louisiana involving the claim of medical providers that their fees for the treatment of injured workers were improperly reduced below the state’s fee schedule. The gist of their argument is that the Louisiana Workers’ Compensation Act does not allow an employer to pay a provider an amount that is below the fee established in the workers’ compensation fee schedule and, alternatively, that the PPO discounts violated the PPO regulation statute in failing to give the provider notice that their PPO contract was being accessed by an employer.  The latter argument is generally referred to as the "silent PPO". For more information on this previous Expert Commentary, click here.

Juge's latest commentary  reflects on the evolving jurisprudence in Louisiana on the issue of which court (state district court or workers' compensation court (OWC)) has subject matter jurisdiction to adjudicate the provider claims and the ancillary claims of other parties (third party claims of employers against the PPO, and the PPO’s right to intervene in the provider/employer dispute).

He characterizes this as being analogous to the problem of fitting a round peg into a square hole.  However, the problem is more accurately portrayed as having two round pegs and two square holes.  The rounds pegs represent the two different and distinct statutory bases of the provider claims, and the square holes represent the two different courts where these claims may be adjudicated.

Juge discusses the following statutes: La. Rev. Stat. § 40:2201, La. Rev. Stat. § 23:1203, La. Rev. Stat. § 23:1201F, and La. Rev. Stat. 23:1310.3E.

He also covers these recent cases: Gunderson, et al. v. F.A. Richard & Associates, Inc. et al., CW 07-331, CW 07-400 consolidated with CA 07-264 (La. App. 3d Cir. 2/27/08), 997 So. 2d 1128, Broussard Physical Therapy v. Family Dollar Stores, Inc. and ACE American Insurance Co. 08-3 (La. App. 3d Cir. 4/9/08), 2008 La. App. LEXIS 509, Beutler Clinic (Cheryl Brown) v. Market Basket No. 27, 05-0952 ( La. App. 3d Cir. 12/30/05), 919 So. 2d 816.